Prevalence and risk factors of cognitive impairment in patients with coronary heart disease: a systematic review and meta-analysis

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Background The prevalence and risk factors of cognitive impairment in patients with coronary atherosclerotic heart disease (CHD) vary substantially depending on the measurement approaches and time points adopted. Through a meta-analysis, we aim to clarify the prevalence and risk factors of cognitive impairment in CHD patients, thereby providing a reference for the implementation of targeted interventions. Methods Computerized searches were conducted across 9 databases, including the China National Knowledge Infrastructure (CNKI), VIP Database, Wanfang Database, China Biomedical Literature Database (CBM), PubMed, Cochrane Library, Embase, Medline, and Web of Science, to retrieve literature on risk factors for cognitive impairment in patients with coronary heart disease (CHD). Searches were run from database inception to July 2025. After literature screening, data extraction and quality assessment, a meta-analysis was performed using Stata 16.0 and RevMan 5.4 software. Results A total of 22 studies were included, involving 9,207 patients. The prevalence of cognitive impairment in CHD patients was 36.6% [95% CI (27.6%–45.7%)]. Meta-analysis and systematic review revealed that age [OR: 1.10 (1.04–1.17), P = 0.001], history of stroke [OR: 1.99 (1.09–3.62), P = 0.02], smoking [OR: 3.05 (2.00–4.66), P < 0.001], diabetes [OR: 2.31 (1.22–4.36), P = 0.01], depression [OR: 1.67 (1.24–2.26), P < 0.001], and anxiety [OR: 2.03 (1.54–2.69), P < 0.001] were significant risk factors for cognitive impairment in CHD patients. In contrast, no significant correlations were observed between cognitive impairment and education level, hypertension, systolic blood pressure, or HDL-C. Conclusion Cognitive impairment is notably prevalent among patients with coronary heart disease (CHD). Specifically, elderly patients, smokers, those with a history of stroke or diabetes, and individuals with negative emotions such as anxiety and depression face a particularly high risk of developing cognitive impairment. Healthcare professionals should identify these high-risk groups as early as possible, conduct dynamic assessments of changes in their cognitive function, and implement targeted interventions to effectively prevent the onset of cognitive impairment. Systematic Review Registration https://www.crd.york.ac.uk/prospero/ , identifier (CRD420251106812).

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